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Catatonic Schizophrenia – Symptoms, Causes, Risk Factors and Treatment

Overview

Catatonic schizophrenia is a serious mental illness and a subset of schizophrenia. An individual who is afflicted with schizophrenia and is also diagnosed with catatonia at the same time is said to be suffering from catatonic schizophrenia. 

Schizophrenia prevents people from distinguishing between reality and imagination. Catatonic schizophrenia typically affects the patient’s movements, thoughts, and speech. In catatonic schizophrenia, the patient may stay still and not talk or get hyperactive for no reason. These symptoms may last for hours or even days. This article delves deeper into the details of catatonic schizophrenia, its causes, symptoms, and various treatment options.

What is catatonic schizophrenia?

As mentioned earlier, catatonic schizophrenia is a subset of schizophrenia disorder. In this disorder, patients may experience periods of immobilisation – where they either have very little mobility or are unable to move at all and are unresponsive to external stimuli such as instructions, speech, and more.

However, in extreme cases, the individual may demonstrate motor activity that may be considered either excessive or peculiar. These activities include mimicking sounds (echolalia) or mimicking movements (echopraxia), and this is known as catatonic excitement.

What are the symptoms of catatonic schizophrenia?

Catatonia may show up in a variety of ways. A commonly observed symptom in individuals with catatonic schizophrenia is limited motor movements even though they are physically capable of mobility. The doctor may diagnose catatonia (or catatonic schizophrenia), if you display at least three of the below 12 features, You:

  1. You stay silent (mute)
  2. Stupor: React very little or are unmoving to what is happening around you 
  3. Mannerisms: Make odd gestures or movements 
  4. Posturing: Hold your leg up or keep other uncomfortable positions for a longer time
  5. Waxy flexibility: Stay locked in an awkward position for a longer time and resist any attempt to move you 
  6. Echopraxia: Mimic someone else’s movements
  7. Echolalia: Mimic someone else’s speech 
  8. Passively let other individuals  position your limbs or other parts or body 
  9. Ignore requests or instructions
  10. Are agitated or hyperactive for no reason
  11. Stereotypy: Repeat senseless gestures, such as rocking, shrugging and waving
  12. Contort your face into a grimace

When you should seek a doctor’s help for catatonic schizophrenia?

When people or their loved ones experience any of the above-mentioned symptoms medical help must be sought immediately.

What are the causes of catatonic schizophrenia?

The causes of catatonic disorders vary from person to person,  but irregularities in dopamine, gamma-aminobutyric acid (GABA), and glutamate neurotransmitter systems are the primary cause.

Schizophrenia is is most likely a result of a combination of genetics and environmental triggers, such as extreme stress.

Experts opine that an imbalance of dopamine, a neurotransmitter, is involved in the beginning stages of schizophrenia. They believe that this imbalance is probably genetic in nature. Levels of neurotransmitters, such as serotonin, can also be involved.

How is catatonic schizophrenia diagnosed?

Doctors may diagnose catatonic schizophrenia by performing some or all of the following tests:

  1. EEG (electroencephalogram)
  2. MRI scan
  3. CT scan
  4. Physical examination
  5. A psychiatric examination performed by a trained professional

The risk factors for schizophrenia may include

  1. Genetics: People with a family history of schizophrenia are at a greater risk of developing catatonic schizophrenia.
  2. Viral infection: A few recent studies suggest that viral infections may predispose children to the development of schizophrenia.
  3. Fetal malnutrition: when the foetus suffers from malnutrition during pregnancy, there is a higher risk of developing schizophrenia.
  4. Extreme stress during childhood – severe stress early in life may contribute to the development of schizophrenia. Stressful experiences may frequently occur before the appearance of schizophrenia.
  5. Trauma or abuse: Childhood trauma or abuse may lead to developing catatonic schizophrenia.
  6. Age of parents at birth: Older parents are at a greater risk of conceiving children who may develop schizophrenia.
  7. Drugs: the use of drugs that affect the mind during the adolescent years may increase people’s risk of developing schizophrenia.

Family history is a risk factor for catatonic schizophrenia. But, an individual’s own lifestyle and behavior may also be related. The episodes of catatonic schizophrenic have also been linked to substance misuse.

What are the complications of catatonic schizophrenia?

If left untreated, catatonic schizophrenia may lead to severe health, financial, and behavioural problems. The complications may include:

  • Depression, suicidal thoughts and behaviour
  • Malnutrition
  • Hygiene issues
  • Substance abuse includes alcohol, prescription medications, and other illegal drugs.
  • A lack of ability to find or maintain employment, thus resulting in poverty and homelessness
  • Serious family conflicts
  • Violent behaviour leads to prison time
  • A lack of ability to study or attend school and other educational institutions

What are the treatment options for catatonic schizophrenia?

Schizophrenia is a lifelong condition but the catatonic symptoms may be temporary. Patients with schizophrenia need treatment throughout their life, even when their symptoms seem to have subsided and it seems that the patient is better. The treatment is essentially the same for all types of schizophrenia.

The methods differ depending on several factors such as the severity and types of symptoms, people’s health, and their age.

Medication

Medicines are the cornerstone of schizophrenia treatment. The most commonly prescribed drugs include antipsychotic medications. The following are the medications that help treat catatonic schizophrenia:

  • Benzodiazepines – these types of medications act as tranquillizers and are used to treat catatonic schizophrenia. This medication is fast-acting and may be injected into a vein (given intravenously). However, there is a risk of dependency in prolonged usage. The patient may have to take this drug for may days or weeks.
  • Barbiturates – these medications are referred to as depressants or sedatives because they suppress the central nervous system. Barbiturates quickly ease the symptoms of catatonia. There is a risk of dependency in prolonged usage.
  • Antidepressants and mood-stabilizing drugs – Individuals with catatonic schizophrenia often suffer from other mental health problems, including depression. These medications help in managing depression and other mental health-related issues.

Brain stimulation

This treatment uses either electrical currents or magnetic pulses to stimulate the brain.

  • Electroconvulsive therapy (ECT) – this procedure may reduce the symptoms by half or in some cases even get rid of them altogether. The doctor may recommend it for patients who have not responded to medications or other treatments. ECT uses short bursts of electric current in the brain. The treatment may lead to confusion and temporary memory loss in patients.
  • Transcranial magnetic stimulation (TMS)- This treatment uses a device that sends out a magnetic pulse to activate nerve cells in the brain. TMS can target specific regions of the brain in a better manner than ECT can. It also leads to fewer memory problems in the patient.   

Hospitalization

Hospitalization may be needed during severe episodes. Patients are safer in a hospital as they are more likely to get proper nutrition, sleep, hygiene, and prompt treatment. 

Psychotherapy

In patients with catatonic schizophrenia, medications are the main part of the treatment. However, psychotherapy may also be useful in certain cases. However, if symptoms are severe,  psychotherapy may not be the appropriate treatment for the patient.

Social and vocational skills training

Social and vocational skills training may help the patient live independently. This is a vital part of their recovery. The therapist may be able to help the patient learn good hygiene, prepare nutritious meals, and have better communication skills. The patient may also receive support in finding work, housing, and joining self-help groups. 

Compliance (adherence)

Compliance (adherence) in medicine means taking the medication at the right time and in the correct dosage. Unfortunately, lack of compliance is a big problem for people with schizophrenia. They may stop taking their medication for long periods, thus letting the condition significantly interfere with their lives and the lives of those around them.

Conclusion

Although schizophrenia can be a lifelong condition, catatonic episodes that are associated with schizophrenia can be treated effectively by an experienced psychiatric team.

Frequently Asked Questions

How do people cope with catatonic schizophrenia?

The best way for people to cope with catatonic schizophrenia is to educate themselves about the diagnosis, symptoms such as erratic and extreme movements, and the correct treatment.

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